Care Coordination & LTSS Oversight & Compliance Senior Manager
Apply NowCompany: UCare
Location: Minneapolis, MN 55407
Description:
ABOUT UCARE
UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.
Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 15 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
CARE COORDINATION & LTSS OVERSIGHT & COMPLIANCE SENIOR MANAGER
The current hiring base salary range for this role is:
$104,966.00/year - $118,087.20/year
UCare anticipates paying within the above-references salary range for this position. The actual base salary offer for this position will be determined by a variety of components including but not limited to work experience, education, certifications, location of the role, internal equity, and other relevant factors.
LOCATION: Minneapolis, MN (Work from Home or Office for Your Day)
Position Description
As the Care Coordination and LTSS (CCL) Oversight and Compliance Senior Manager, you will be responsible for managing the foundational and strategic relationship and regulatory oversight accountabilities that support all aspects of Care Coordination & LTSS (CCL). Serve as a key member of the department and oversight efforts designed to strengthen a culture that promotes collaboration and regulatory readiness. This position will assist with setting priorities for SNP care coordination programs, including, but not limited to, process improvement strategies, organizational goals, regulatory guidance and data. Interpret and apply NCQA, state and federal regulatory mandates to support operational assessments, regulatory readiness and accreditation. You will oversee the implementation of these priorities to ensure contractual, and regulatory requirements are disseminated and understood by all stakeholders. You will also maintain relationships with delegated entities to assist in positive collaboration and open communication. In addition, you will be responsible for the program management of UCare's SNP programs, which will include: coordination and administration of a broad scope of (CCL) program activities, projects and initiatives including practice management, delegate oversight, and preadmission screenings.
Education
Social Worker or RN with requisite experience. Current and unrestricted license in Minnesota required.
Required Experience
Six years of health care, regulatory experience in the health care industry. Experience working with and interpreting state and federally funded program benefits, including Medicare and Medicaid is required. At least two years of experience supervising professional staff. Experience with health care-related regulatory compliance, auditing, or surveying. NCQA experience.
Preferred Experience
Experience with application of NCQA Federal and state regulatory standards. Knowledge of provider contracting strategies is highly desirable.
THE UCARE DIFFERENCE
The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.
BENEFIT ELIGIBLITY
Candidates hired into this position will also be eligible to participate in the following benefit programs: Paid Time Off; Earned Safe and Sick Time; Paid Holidays; Parental Leave; 401K program; medical, dental, vision, life insurance; short-term and long-term disability insurance; Flexible Spending Account and/or Health Savings Account, subject to meeting the eligibility requirements and terms and conditions of these programs.
This job posting should not be construed as an offer of employment with certain terms, nor should it be construed as a guaranteed minimum. UCare's policies and benefits are subject to change in UCare's sole discretion, consistent with applicable law.
UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.
WORKING AT UCARE
Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.
Our strong culture has established UCare as a Star Tribune Top 200 Workplace for 15 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.
CARE COORDINATION & LTSS OVERSIGHT & COMPLIANCE SENIOR MANAGER
The current hiring base salary range for this role is:
$104,966.00/year - $118,087.20/year
UCare anticipates paying within the above-references salary range for this position. The actual base salary offer for this position will be determined by a variety of components including but not limited to work experience, education, certifications, location of the role, internal equity, and other relevant factors.
LOCATION: Minneapolis, MN (Work from Home or Office for Your Day)
Position Description
As the Care Coordination and LTSS (CCL) Oversight and Compliance Senior Manager, you will be responsible for managing the foundational and strategic relationship and regulatory oversight accountabilities that support all aspects of Care Coordination & LTSS (CCL). Serve as a key member of the department and oversight efforts designed to strengthen a culture that promotes collaboration and regulatory readiness. This position will assist with setting priorities for SNP care coordination programs, including, but not limited to, process improvement strategies, organizational goals, regulatory guidance and data. Interpret and apply NCQA, state and federal regulatory mandates to support operational assessments, regulatory readiness and accreditation. You will oversee the implementation of these priorities to ensure contractual, and regulatory requirements are disseminated and understood by all stakeholders. You will also maintain relationships with delegated entities to assist in positive collaboration and open communication. In addition, you will be responsible for the program management of UCare's SNP programs, which will include: coordination and administration of a broad scope of (CCL) program activities, projects and initiatives including practice management, delegate oversight, and preadmission screenings.
- Oversee teams' performance of oversight and compliance activities. Support team members in meeting performance metrics and conduct supervisory oversight of staff/delegate interactions. Establish regularly scheduled team meetings and one-on-one meetings with direct reports at a minimum of once per month. Assist team members with problem solving complex audit, delegate feedback or preadmission screening situations.
- Partner with the members of the (CCL) Leadership Team to design and implement compliance infrastructure, including processes and tools for administering the compliance program. This may include helping to ensure the proper design and implementation of internal controls and operating policies and procedures.
- Apply knowledge of State, Federal, and other regulating bodies to analyze internal and delegated practice standards. Additionally, apply this knowledge to delegate performance feedback.
- Support the regulatory reporting requirements for SNP products. Prepare and submit annual product and MOC evaluations, audit result summaries, and DHS required care coordination reporting.
- Monitor the annual review period for department policies and procedures. Prepare documents for leader review including content and formatting. Manage submission process in accordance with meeting deadlines.
- Lead the writing of the SNP Model of Care documents. Collaborate with members of the (CCL) Leadership Team, contributors from other departments, and identified subject matter experts to gather information. Analyze and integrate the information into the SNP Model of Care.
- Outline, implement, present and create a report on an accessibility survey. Consult with internal and external stakeholders regarding the topic and the results. Create an action plan based on survey findings. Oversee the implementation of the action plan.
- Oversee the Care Coordination Grids. Partner with the auditors and clinical liaisons to update the language while providing sound, regulatory reasoning for updates that can be explained and implemented in a timely way, including allowing time for training to occur, and for supportive documentation to be publicly posted for delegates to access.
- Understand the care coordination processes within UCare and delegated entities in order to oversee and guide their ability to comply with contractual obligations.
- Oversee the development and implementation of auditing tools and strategies to fully analyze the ability to achieve optimal compliance with regulatory standards and meet contractual obligations.
- Oversee the coordination and implementation of delegate and internal audits, including interrater reliability audits. Oversee implementation of project plans, statement of work, and/or process flow related to different projects, and be able to prepare results analysis.
- Oversee the completion of corrective action plans and other strategies to monitor the progress of each delegated entity on an ongoing basis. Escalate repeat audit findings, for action. Present findings as directed to delegated entities, Care Coordination & LTSS, Provider Network Management, and other UCare staff as appropriate.
- Oversee the completion of pre-delegation assessments, as necessary, to ensure the entity has the capacity and capability to perform delegated functions. Responsible for the preparation of written reports of assessments and communicating results to leaders and delegated entities.
- Participate in audits conducted by UCare's regulators as directed, including identifying the universe and gathering records, preparing files, and providing information to auditors as requested.
- Coordinate and facilitate meetings with internal and external entities to disseminate information, clarify processes, escalate compliance risk, and ensure corrective action as needed.
- Develop and maintain positive relationships with internal and external entities, in order to increase cooperation and compliance with regulatory requirements.
- Provide oversight of and assist with strategic planning for the Delegation Oversight Auditors and preadmission screening roles.
- Other projects and duties as assigned.
Education
Social Worker or RN with requisite experience. Current and unrestricted license in Minnesota required.
Required Experience
Six years of health care, regulatory experience in the health care industry. Experience working with and interpreting state and federally funded program benefits, including Medicare and Medicaid is required. At least two years of experience supervising professional staff. Experience with health care-related regulatory compliance, auditing, or surveying. NCQA experience.
Preferred Experience
Experience with application of NCQA Federal and state regulatory standards. Knowledge of provider contracting strategies is highly desirable.
THE UCARE DIFFERENCE
The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.
BENEFIT ELIGIBLITY
Candidates hired into this position will also be eligible to participate in the following benefit programs: Paid Time Off; Earned Safe and Sick Time; Paid Holidays; Parental Leave; 401K program; medical, dental, vision, life insurance; short-term and long-term disability insurance; Flexible Spending Account and/or Health Savings Account, subject to meeting the eligibility requirements and terms and conditions of these programs.
This job posting should not be construed as an offer of employment with certain terms, nor should it be construed as a guaranteed minimum. UCare's policies and benefits are subject to change in UCare's sole discretion, consistent with applicable law.